[golfing eagles]

Originally Posted by dbussone

Excellent post. And since GE asked, I will weigh in.

Having observed, used, and survived some ERs, not all are equal. Once one is seriously broken, as is TVRH's, it can be very difficult to turn around. I've turned around a couple in my career so I speak from experience.

What I'm posting here has been written and told to the hospital leadership. There are a number of issues that are easily noted for someone like GE so let's see if he agrees with my analysis.

First problem, the ER docs are lazy. They have no skin in the game and act like they really don't give a darn. They certainly aren't oriented toward productivity. SOLUTION: hire a new ER group, and make sure the contract speaks to quality and productivity standards.

Second problem, the hospital employees have a terrible attitude. It shows in the way they interact with each other and patients. I believe the attitude has rubbed off from the docs. SOLUTION: Replace the docs, and have all employees take a mandatory course on customer relations. Disney offers these, and they will teach it on site.

Third problem (and this one is literally a killer), best practice protocols are not being followed. When a patient arrives at the hospital with chest pain, there are practices that must be put in place immediately. Although anecdotal, there is sufficient evidence to believe cardiac and other protocols are not always followed. SOLUTION: Replace the ER group. There should also be a medical staff committee that reviews records to assure QA. I'd recommend that the committee investigate certain protocols to be sure they are being followed. Where appropriate it may be necessary to require education, or restrict privileges.

Fourth problem, they invested millions to the expand the ER...most likely hoping construction would resolve many of the issues discussed here and in other threads. The problems have remained. And IMO, the ER docs are the bottleneck. SOLUTION: fire the ER docs, and bring in a consultant to assess patient flow and staff work patterns.

That's enough for now. What do you think GE?


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I agree 100%, I think I touched on most of this as well. ER culture tends to manifest itself from the top down. I don't know about all the ER docs here, but the one we had , gave at least the impression of laziness. He also seemed to have the knowledge base I expected from my interns and 2nd year residents. Did he do the right thing---yes. Was he happy about being there---no. Did he do it anywhere near as quickly as I could have---not even close. I agree QA needs to be stepped up, as well as a review of admission protocols.